Hacker News Reader

Comment by willcipriano | Hacker News Reader

Couldn't be that doctors wanted all those easy well visits writing scripts for birth control and the recent supreme court ruling encouraged the FDA to finally be reasonable? It's that this exact moment is the first time in human history that women are capable of understanding "once daily".

View on HN

> It's that this exact moment is the first time in human history that women are capable of understanding "once daily".

Contraceptives have a long-standing problem of people being unable or unwilling to follow the instructions, or not catching little nuances like "this pill lasts for 22 hours, so you really need to take it every day at the same time". For a decent-looking summary, see ex. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ which includes a lot of lines like,

> Hatcher and colleagues report that for both types of pills, the failure rate is less than 1% with perfect use and 7% with typical use.

So no, empirically, it appears likely that people are not capable of understanding "once daily".

Empirically, how much does visiting a doctor change people’s understanding of “once daily”? Measured in percentage terms. Because that’s the important question here.

They have some data in the links in the article. There could be some bias there (pharma likes to guide subject answers, and they dont provide the methodology details), so we would probably need real world data. But based on that limited data it appears to be no different. In theory, the longer the pill is in use and the more people who use it, then the more likely it is that people in society understand that it's one's a day at the same time of day etc.

So literally a vibrating pill box that stays lit and sends smart reminders until someone takes their pill would be 10,000x more effective and cost vastly less than the appointments+opportunity cost+lifestyle cost forced on women by profiteers. Or one of those special purpose reminder apps. Or Google Calendar…

An app can deliver periodic reminders about the potential negative effects of birth control pills. It can have a conversational interface for when someone is having issues with a particular pill, thinking about starting a new pill or type of contraceptive, etc…

How does the pill being prescribed by a doctor help this? Do you think doctors are actually explaining this to patients? They are not. They don't have time. The PE firms who own them won't let them take the time.

I would expect someone to explain it; if not technically a doctor then a nurse or such, which is consistent with my experience of medical appointments.

I'm going to take a wild guess you have never been prescribed BCP.

No, no one explains it. They expect you to read the instructions, which is not an unreasonable expectation.

Depends on the result we are expecting as to if it's unreasonable. I would guess at least half of people do not read the paper you get with the medication (any meds).

Sure, it should be explained, but the point is that there's no value in only enabling a scarce resource (doctors) to explain something that doesn't require any medical training (take this once a day at the same time).

The pharmacist can explain it. You can put it in huge text on the packaging. You can text or email people.

You could literally make someone DocuSign a single page PDF that just says "THIS ONLY WORKS CORRECTLY IF YOU TAKE IT AT THE SAME TIME EVERY DAY" in order to get their prescription.

All of these options get the exact same message across without being inconvenient and causing people to miss taking their birth control because they couldn't get a doctor's appointment, etc. There are costs to making people go into a medical office that you can't ignore here.

"All of these options get the exact same message across without being inconvenient and causing people to miss taking their birth control because they couldn't get a doctor's appointment, etc. There are costs to making people go into a medical office that you can't ignore here."

I mean, the alternative already exists - online appointments. You can even get auto renewing prescriptions through the mail.

What is the need for any kind of appointment with a doctor? There is literally no medical expertise required for what we're talking about here. There is the need to relay an instruction that almost anyone can understand. Why is it a good idea to force patients to make any kind of appointment and to take up the time of very highly trained medical professionals, in order to say "TAKE THIS AT THE SAME TIME EVERY DAY"?

You could train a dog to pass that message across using some of those buttons that say words when pressed. That would actually probably be much more effective than having it come from a doctor, because the dog thing would be much more memorable.

> So no, empirically, it appears likely that people are not capable of understanding "once daily".

Hilariously, almost all of the "failure rate" of vasectomies is due to people who don't follow the doctor's instructions for how to handle the first few weeks after (you've still got some live swimmers with access to the outside, for a while). Other reasons for failure are so vanishingly rare they're hardly worth mentioning.

So you're thinking about getting the surgery, see the failure rate and are like, "damn, that's low but still a lot higher than I'd expect, given I'm committing to nut surgery"—but no, as long as you don't do the single thing you're not supposed to for the first few weeks, it's basically 100% effective.

Doesn’t sound plausible. Doctors aren’t really casting around for work, these visits aren’t particularly or unusually straightforward for a GP - and at a guess a majority of women who stay on hormonal birth control have had some problems with it at some point. The cultural knowledge aspect is real.

Some people react very badly to hormonal contraceptives, to the degree that it makes a lot of sense to have them actively prescribed so the GP can watch for (or at least warn to watch for) side-effects.

I know people who can't take them because they make them suicidal, of the "spontaneously walking into fast-moving traffic" sort. I don't know if that would happen with this type specifically, but there are reasons to be cautious.

Yeah, I was a bit shocked to see this. Not because it shouldn't be easily accessible, but because most women I've talked to about this has gone through some sort of dialing in process. Whether its for dosage or a different brand. Hormones are not easy.

I should point out that if this specific type is known to be safe... yeah, dish them out like tic-tacs. Fill your footwear of choice.

No medication is completely safe. Any medication approved for use has to be "generally safe" when used correctly. So basically all meds can be dangerous or safe. It's all about informed consent and proper use.

Well exactly. In this case it's more a matter of whether the move to non-prescription introduces significant new risks both that didn't exist before and that the layperson shouldn't be expected to be able to handle.

There's more to it than once daily. I doubt the Supreme Court ruling had any logical impact on the FDA decision, unless it was only an empty political gesture (no real contraception restrictions right now). It's more likely that phrama makes more on Rx prescriptions and had no incentive to make it OTC.

Doctors (the ones writing the prescriptions) aren't involved in this process at all.

The AMA is absolutely involved in the medical regulation arena. What are you talking about?

AMA != Most prescribing doctors. Best estimates are only ~20% of doctors are even members of the AMA, with some as low as 15:

https://www.physiciansweekly.com/is-the-ama-really-the-voice...

There are many doctors who really hate the AMA. I know a couple.

Reply on news.ycombinator.com